High rate of microbleed formation following primary intracerebral hemorrhage

Int J Stroke. 2015 Dec;10(8):1187-91. doi: 10.1111/ijs.12607. Epub 2015 Aug 26.

Abstract

Background: We sought to investigate the frequency of microbleed development following intracerebral hemorrhage in a predominantly African-American population and to identify predictors of new microbleed formation.

Aims and/or hypothesis: To investigate the frequency and predictors of new microbleeds following intracerebral hemorrhage.

Methods: The DECIPHER study was a prospective, longitudinal, magnetic resonance-based cohort study designed to evaluate racial/ethnic differences in risk factors for microbleeds and to evaluate the prognostic impact of microbleeds in this intracerebral hemorrhage population. We evaluated new microbleed formation in two time periods: from baseline to 30 days and from 30 days to year 1.

Results: Of 200 subjects enrolled in DECIPHER, 84 had magnetic resonance imaging at all required time points to meet criteria for this analysis. In the baseline to day 30 analysis, 11 (13·1%) had new microbleeds, compared with 25 (29·8%) in the day 30 to year 1 analysis. Logistic regression analysis demonstrated that baseline number of microbleeds [odds ratio 1·05 (95% confidence interval 1·01, 1·08), P = 0·01] was associated with new microbleed formation at 30 days. A logistic regression model predicting new microbleed at one-year included baseline number of microbleeds [odds ratio 1·05 (1·00, 1·11), P = 0·046], baseline age [odds ratio 1·05 (1·00, 1·10), P = 0·04], and white matter disease score [odds ratio 1·18 (0·96, 1·45). P = 0·115]. Overall, 28 of 84 (33·3%) intracerebral hemorrhage subjects formed new microbleeds at some point in the first year post-intracerebral hemorrhage.

Conclusions: We found that one-third of intracerebral hemorrhage subjects in this cohort surviving one-year developed new microbleeds, which suggests a dynamic and rapidly progressive vasculopathy. Future studies are needed to examine the impact of new microbleed formation on patient outcomes.

Keywords: MRI; brain bleed; brain microbleeds; cerebral hemorrhage; hemorrhage; intracerebral hemorrhage.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Brain / pathology
  • Female
  • Humans
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / ethnology
  • Intracranial Hemorrhages / etiology*
  • Intracranial Hemorrhages / pathology
  • Logistic Models
  • Longitudinal Studies
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stroke / complications*
  • Stroke / diagnosis
  • Stroke / ethnology
  • Stroke / pathology
  • Time Factors
  • United States / epidemiology